Idaho Health and Welfare reorganizes leadership, shifts programs to align budget and operations

The Idaho Department of Health and Welfare told the Joint Finance-Appropriations Committee on Jan. 13 that it has reorganized leadership and moved several programs between divisions to align budgeting with how work is actually administered.

Director Alex Adams and Legislative Services budget analyst Alex Williamson outlined changes that include creating a chief financial officer who reports directly to the director, adding a fourth deputy director to separate responsibility for Medicaid and child welfare, and establishing a chief over legislative and regulatory affairs. The agency distributed an organizational chart showing 22 leadership seats; department officials said 15 of those roles are new or in new seats.

Major program shifts described to the committee include moving behavioral health staff and the Medicaid program integrity unit (the unit that investigates Medicaid fraud) under Medicaid; placing the Idaho Child Care Program (ICCP) under a newly named Early Learning and Development division with its own appropriation unit; and moving Extended Employment Services (EES) and community developmental disabilities budget programs into Medicaid because Medicaid staff currently administer those programs. The department also requested renaming and regrouping several divisions: Family and Community Services would be split out; Support Services and Licensing would be renamed Division of Operations; Public Health and Self Reliance would be grouped under Health and Human Services; and Developmental Disability Services would be retitled Early Learning and Development. Child welfare would be retitled Youth Safety and Permanency.

Adams told the committee the changes are meant to improve lines of visibility and accountability across an agency he described as large and complex: "How you structure that organization matters," he said, adding that he has "a budget-first mentality" and that budgets are laws to be lived within. He described the department as operating roughly 3,000 employees across 74 buildings at 37 locations and said the reorganization aims to align where staff work with how the legislature budgets those programs.

Legislative analysts said the request from the agency is to align the program maintenance budget so that the appropriation structure mirrors how the department is organized in practice. Committee members asked for additional detail and said staff would work with the department in scheduled work groups and future hearings to review how decision units will appear in motions and appropriation bills.